Key Correspondentshttp://www.keycorrespondents.org
The Key Correspondents team is a vibrant network of citizen journalists from Africa, Asia and Latin America. KCs report the HIV, health and human rights stories affecting them and their communities and in doing so ‘speak their world’.Thu, 30 Jul 2015 10:21:36 +0000en-UShourly1http://wordpress.org/?v=4.2.2Zambia: 23 babies born with HIV daily says UNAIDShttp://www.keycorrespondents.org/2015/07/30/zambia-23-babies-born-with-hiv-daily-says-unaids/
http://www.keycorrespondents.org/2015/07/30/zambia-23-babies-born-with-hiv-daily-says-unaids/#commentsThu, 30 Jul 2015 10:18:14 +0000http://www.keycorrespondents.org/?p=18597more →]]>UNAIDS’ Zambia country director says that despite good progress made in responding to HIV in the last ten years, Zambia is ranked tenth globally for the highest number of people living with HIV.

Dr Medhin Tsehaiu was speaking at the Alliance of Mayors and Municipal Leaders Initiative for Community Action on AIDS at the Local Level (AMICAAL) on 29 July.

“Around 8,000 babies are born from mothers living with HIV annually, meaning that 23 babies are born HIV positive every day,” Dr Tsehaiu said. “We must reverse this situation, these infections could have been averted by effectively implementing option B+ which means putting mothers on lifelong antiretroviral therapy.

“I must state that this is a low hanging fruit. Zambia could achieve the target of elimination of mother to child transmission by the end of 2015 if all of us do our part because it really requires leadership at all levels.”

Declining HIV rates

Dr Tsehaiu added Zambia’s HIV prevalence is declining. “New infections have also been reduced from 82,000 in 2007 to around 54,000 in 2014 which means that there are about 54,000 new infections every year which is a good achievement,” she said.

Despite this progress, inequality between men and women remains a significant challenge that still needs addressing, particularly with regards to high levels of gender-based violence (GBV) as well as barriers women face in accessing HIV services.

Dr Tsehaiu said: “Principals of gender equality must be applied across the response and every effort must be made to reduce GBV and inequality at all levels.”

“I am pleased to inform you that the AIDS target for millennium development goal six which relates to halting and reversing the spread of HIV globally has been achieved, and even exceeded the target of putting 15 million people on ART before the deadline of 2015,” Dr Tsehaiu said.

She also noted that although there are 15 years to reach the new vision of ending AIDS, the next five years will be critical in determining if that goal can be achieved.

HIV treatment in Zambia

AMICAAL chairman Nathan Chanda Bwalya said the number of people on HIV treatment in Zambia has increased from 3,500 in 2004 to 671,000 in 2014.

Bwalya said: “The Government, in line with WHO guidelines, has decided to administer antiretroviral therapy to people that have a CD4 count of 500. This will inevitably increase people on antiretrovirals, however despite this seemingly impressive achievement our HIV prevalence still remains very high and what is more worrisome is the rate of new infections among our young people.”

According to Dr Tsehaiu Zambia currently has about 500,000 people living with HIV who do not know their status. “We must promote HIV testing which is the entry point to treatment,” she said.

Bwaylya added: “I am appealing to all local authorities for initiatives that will lead to a reduction of new HIV infections among young people. I implore you to provide the leadership that is required in responding to this challenge. The leadership we need should be the leadership for lack of better words I will describe as ‘positive infectious leadership’ a leadership that acts and lives what it preaches. Let us ensure that we put in place projects and programmes that improve the lives of the people we have been elected to serve.”

Funding the HIV response

National AIDS Council chairperson Dr George Tembo also urged the local governments not to be complacent to avoid an increase of new HIV infections, especially among young people.

“We need as much as possible to put focus on prevention, we have done extremely well in other areas but we need to make sure that our eyes are focused on things that will sustain and not erode our achievement,” Tembo said.

He appealed to local governments to be innovative and raise their own financial resources as dependence on donor funds is not sustainable.

“We need to look at innovative ways of raising funds. The responsibility of the AIDS response is not only the responsibility of government alone, it is also the responsibility of all of us, it starts from the family, and individuals from the community,” Tembo said.

“How are we working with the private sector? How are we utilising the constituency development funds? How are we going to utilise the levies? It’s all these methods that we need to look at if the HIV response is going to be sustained.”

]]>http://www.keycorrespondents.org/2015/07/30/zambia-23-babies-born-with-hiv-daily-says-unaids/feed/0Dorothy’s story: living with HIV and unmet family planning needshttp://www.keycorrespondents.org/2015/07/27/dorothys-story-living-with-hiv-and-unmet-family-planning-needs/
http://www.keycorrespondents.org/2015/07/27/dorothys-story-living-with-hiv-and-unmet-family-planning-needs/#commentsMon, 27 Jul 2015 10:42:42 +0000http://www.keycorrespondents.org/?p=18586more →]]>Dorothy Mirembe, from Nsambya a suburb of Kampala in Uganda, is a smiling, energetic woman who is full of life. It’s hard to imagine that ten years ago she was pale and thin, and hid herself from the world.

“I used to cover myself like Muslims so that no one would recognise me,” she says. “I was so thin that the wind blowing could push me down. I avoided contact with people and spent most of the time indoors and lonely. Not even my relatives could come near me. I was in self stigma, I was traumatised and living in discrimination.”

At age 18, Dorothy had fallen pregnant. The pregnancy was not intended, and she was very weak. When she attended an antenatal clinic at Mulago Hospital, she tested HIV positive.

Preventing unintended pregnancies among women living with HIV is one of the World Health Organization’s four cornerstones of preventing mother to child transmission of HIV. However, according to the Uganda Demographic and Health Survey, the fertility rate in Uganda has remained persistently high at 6.7 per cent and there is a high maternal mortality rate of 438 per 100,000 live births.

Contributing factors could include a low contraceptive prevalence of 26 per cent and a high unmet need for family planning of 34.3 per cent. Unmet need is the percentage of women who want to space their births, or do not want to become pregnant, but are not using contraception.

“When a counsellor gave me the results, I knew death had knocked on my door,” she said. “I went back home and cried behind closed doors. I didn’t disclose my status because of the fear and humiliation I expected from people around me.”

In fact, Dorothy’s family had guessed she was living with HIV but were afraid to speak to her about it. “Anyone mentioning HIV was an enemy to me,” Dorothy says.

“I was pregnant and contracted tuberculosis, so I was bed ridden for three weeks. The only thing I was thinking of was my unborn baby. At Mulago, I was offered care and counselling from different volunteers at the hospital. They visited and assisted me and gave me food and moral support. After I was discharged, the volunteers continued to support me until I finally recovered.”

When Dorothy returned home, an ICWEA volunteer in her neighbourhood approached her. The woman was also living with HIV and was taking antiretroviral drugs.

“She advised me to go to the family planning clinic in Mulago Referral Hospital and receive counselling and treatment,” says Dorothy. “I joined the group where I learnt many things. If it were not for them, I would be dead. They supported me and I gave birth to a baby boy who was free from HIV. This was for what I had been praying, for my kid to be safe.”

Preventing unintended pregnancies

After giving birth, Dorothy received family planning advice at Mulago Hospital. She was given a long-term contraceptive implant to prevent her falling pregnant again.

Through continuous engagement, Mulago Hospital identifies and refers mothers with HIV to services to prevent transmission of the disease to their child. Peer educators living with HIV identify clients in need of family planning. They are then trained in long term and short term contraception methods.

This approach aims to increase uptake of long term methods such as contraceptive implants and intrauterine devices to prevent unintended pregnancies. It also promotes short term methods where appropriate, including condoms, pills and injectable contraceptives.

Mapping people living with HIV

In 2014 Uganda passed a law which criminalises HIV transmission. According to Lillian Mwoleko, executive director of ICWEA, many women do not want to disclose their status, fearing their husbands will use the law against them.

“The law tells us about the mandatory testing, which is not bad, but the way it is carried out is not favorable for women,” she says. “Each woman is supposed to test for HIV as soon as she visits an antenatal clinic, so you will find that the woman will be the first to know her HIV status and will fear to disclose it to her husband. If she discloses, her husband will think she infected him and that’s how the law comes in of who infected who.”

She adds: “We have 7,630 members from five countries, with many members from Uganda. We map these women from village health facilities, especially young women. We counsel and guide them and then we refer them to main hospitals for family planning services and further medication and treatment. We train women to identify others who cannot come up to identify themselves.”

Dorothy has been volunteering with ICWEA for nearly a year and uses her experience to reach out to other people living with HIV.

“I visit at least two clients in a day and give them moral support,” she says. “Because we are many volunteers with a schedule, we always know who is going to the hospital visits or home visits. I have managed to reach 20 households and 20 people, which is a good achievement.”

]]>http://www.keycorrespondents.org/2015/07/27/dorothys-story-living-with-hiv-and-unmet-family-planning-needs/feed/0How empowering women helps HIV responsehttp://www.keycorrespondents.org/2015/07/14/how-empowering-women-helps-hiv-response/
http://www.keycorrespondents.org/2015/07/14/how-empowering-women-helps-hiv-response/#commentsTue, 14 Jul 2015 10:09:55 +0000http://www.keycorrespondents.org/?p=18580more →]]>Women having control over choices about their lives, including their sexuality, is crucial in the fight against HIV and something Virginia Muwanigwa, chairperson of the Women’s Coalition of Zimbabwe, is keen to highlight.

“When women are empowered and they are committed to social and gender justice, this translates into social agency to work against discriminatory practices beginning in the family and household, the community, nation and beyond,” Muwanigwa says.

“The empowerment of women manifests itself through increased voice, more choices and control over their lives and those of their children.”

But making this happen in the face of cultural practices which award most decision-making powers to men, and thereby subordinating women, can be challenging.

Women and HIV

“Research has shown that some women become complicit in harmful cultural practices such as marrying off a child, sometimes to their rapist, because they are dependent on the men while making those decisions,” says Muwanigwa.

There is an urgent need to tackle these issues which put women and girls at greater risk of HIV, as well as presenting other life challenges.

Patience Ziramba, editor of Priority Projects Publishing, which has produced several books on women and gender development, says that the first step in protecting women against HIV is to empower them and appreciate that they can make firm decisions for themselves.

“Mothers are known to be closer to their children and are generally unlikely to endanger their children by marrying them off to some old man,” she says. “However, because women are not firmly empowered, they end up conforming to the demands of their husbands.”

According to Ziramba, it is also about empowering women in relation to their sexuality, as many women have little say in what happens during sexual intercourse, such as the use of protection.

Child marriage

There are many reported cases in which women have fallen victim to actions undermining and violating their human rights such as forced early marriage and rape. Girls Not Brides – a global organisation working to address child marriage – reports that in Zimbabwe it’s estimated that 31 per cent of girls are married before their eighteenth birthday.

Several reasons have been identified as causes of these forms of abuse including weakly formulated policies – often enacted by male politicians – which leave women, and especially young girls, vulnerable.

For example, an article published by The Herald newspaper on 9 June reported that lawmakers are “worried by what appears to be the trivialisation of child sex abuse by the courts, with the age of consent in Zimbabwe now effectively 12 years.”

Age of consent

Although the Zimbabwean constitution is clear on the age of consent to sexual activity, which is 16, legal developments over the past few years have seen child sex predators getting away with community service sentences and other lesser charges.

The constitution defines a child as “every boy and girl under the age of eighteen years” and states that every child has the right to be “protected from economic and sexual exploitation, from child labour, and from maltreatment, neglect or any form of abuse.”

The development around lowering the age of consent to 12 has however left children, especially girls, exposed to sexual abuse, rape, early marriage and at high risk of contracting HIV and related diseases.

Children’s rights

For a girl, underage sex – which is the prime cause of teen pregnancies – can mean the end of her education as the Zimbabwean education sector does not encourage pregnant girls to take normal classes in government schools.

Also, according to the Zimbabwe Human Rights NGO Forum, “married girls are more likely to contract sexually transmitted diseases including HIV and AIDS than unmarried girls and are often powerless to demand the use of contraception or protection during sex.”

It is therefore imperative that, as part of the fight against HIV women are empowered, and preventing early marriage is prioritised. A report by the United Nations Population Fund – Marrying too young: end child marriage – also emphasises how girls themselves must be involved and empowered in seeking a solution to these issues.

In Zimbabwe, it will likely take a strong and concerted effort from civil society, to really see change. As Muwanigwa says: “Communities can raise awareness and build knowledge through education on the causes, extent and impact of the violation of children’s rights. They can also push for the alignment of laws, policies and practices with the letter and spirit of the constitution which says that anyone under 18 years is a child.”

]]>http://www.keycorrespondents.org/2015/07/14/how-empowering-women-helps-hiv-response/feed/0Uganda’s vulnerable children have brighter future thanks to SUNRISEhttp://www.keycorrespondents.org/2015/07/07/ugandas-vulnerable-children-have-brighter-future-thanks-to-sunrise/
http://www.keycorrespondents.org/2015/07/07/ugandas-vulnerable-children-have-brighter-future-thanks-to-sunrise/#commentsTue, 07 Jul 2015 08:00:24 +0000http://www.keycorrespondents.org/?p=18563more →]]>Uganda’s SUNRISE-OVC project*, managed by the International HIV/AIDS Alliance, has helped more than 374,000 orphans and vulnerable children over the last five years. The project, which was funded by USAID, officially ended in June.

Dr Alvaro Bermejo, executive director of the Alliance, handed the project over to Uganda’s Ministry of Gender, Labour and Social Development at a ceremony on 26 June. The Ugandan Red Cross has also taken over responsibility for running some of the services set up by the project.

Since June 2010, SUNRISE has reached 80 districts, covering 71 per cent of the country. Its services included child protection, care, legal support, family re-integration and psychosocial support. It also reached one million children indirectly, by strengthening government systems to support and safeguard vulnerable children.

Supporting livelihoods and education

Josephine Namakula (57) as cared for her three grandchildren Steven Ssali (6), Grace Nantongo (8) and Martin Segawa (11) since the death of her son, the children’s father. She lives in a wattle house at Kiringete sub-county, Mpigi district. Thanks to systems set up by SUNRISE, the future of the family’s livelihood and the children’s education is more assured.

The children are now enrolled in school and Grace’s grandmother is enrolled in a farmers’ group of 15 households. The Red Cross supplied with them with 500,000 shillings (about US$190) to start up small village banks and the group saves through the Kiringente sub-county saving scheme, set up by the government. This ties in with SUNRISE’s objective of linking families to other service providers and government programmes. This work will continue to support orphans and vulnerable children in this community into the future.

Protecting the rights of children

Speaking at the official closing ceremony for the project, Dr Bermejo said: “The true measure of any society can be found in how it treats its weakest citizens. If that is true, there is no task more important than ensuring the rights of orphans and vulnerable people are respected, their welfare protected, and that their lives are free from fear and want.

“The circumstances that shape the life of every child were laid by his or her parents. Through what we do today, we too are laying the foundations for the future and we must consider the wellbeing of each child as the heart of the country’s future.

“The International HIV/AIDS Alliance was selected as lead implementer for this ambitious project, we are immensely proud to have participated. We have achieved wonderful goals. For example, we were required to directly reach 350,000 vulnerable children and we have reached 370,000.”

This number is just the tip of the iceberg because the project has strengthened systems for supporting and protecting children across Uganda. This means it has benefited Uganda’s entire population of six million orphans and vulnerable children, and all other children in the country.

Dr Bermejo added: “That multiplier effect is only possible when the Ministry of Gender, Labour and Social Development, together with local government, carries on the best practices established. It is upon this nation to increasingly step up its priorities and invest more in its children, especially orphans and vulnerable children.”

Training for government workers

As part of the project, SUNRISE trained voluntary community support workers for families with orphans and vulnerable children, called para-social workers. They complement the role of the government’s community development officers as frontline workers for child protection and care. They live in the same villages as the children, which helps them to identify problems quickly.

Wilson Mululi Mukasa, minister of gender, labour and social development, said: “SUNRISE has also built capacity of probation officers, who have been trained in many aspects, all of which have improved their performance. My humble request is that the Ministry will find ways of continuing what the project has established. I am glad to know that local government effectively planned, managed and coordinated the implementation of comprehensive services for orphans and vulnerable children at all levels.

“We thank International HIV/AIDS Alliance UK for their support and effort. The government hopes to work with you again.”

*The project’s full name is Strengthening the Uganda National Response for Implementation of Services for Orphans and other Vulnerable Children.

]]>http://www.keycorrespondents.org/2015/07/07/ugandas-vulnerable-children-have-brighter-future-thanks-to-sunrise/feed/0Global Fund approves $17 million for new HIV programmes in Africahttp://www.keycorrespondents.org/2015/07/06/global-fund-approves-17-million-for-new-hiv-programmes-in-africa/
http://www.keycorrespondents.org/2015/07/06/global-fund-approves-17-million-for-new-hiv-programmes-in-africa/#commentsMon, 06 Jul 2015 14:50:20 +0000http://www.keycorrespondents.org/?p=18567more →]]>The Global Fund to Fight AIDS, TB and Malaria has granted around US$17 million to two consortia of organisations focussing on key populations most affected by HIV, to combat the disease across eastern and southern Africa.

This is the first time so many regional and national partners have come together in this way to put the focus firmly back on strengthening community and civil society organisations to support the HIV response among those most affected.

The southern Africa programme, ‘Key Populations – Representation, Evidence and Attitude Change for Health Impact’ (KP REACH), with a budget of US$11.4 million will be implemented over three years in Botswana, Zimbabwe, Namibia, South Africa, Lesotho, Swaziland, Zambia and Malawi.

With a budget of US$5.5 million, the eastern Africa proposal focuses on reducing the risk of HIV infection among people who inject drugs and will be implemented in Ethiopia, Burundi, Kenya, Mauritius, Seychelles, Uganda, Tanzania and Zanzibar.

The two proposals bring together existing regional networks of key populations (people most at risk of HIV), regional and national civil society organisations, the private sector and research institutions. The Kenya AIDS NGO Consortium (KANCO), a linking organisation of the International HIV/AIDS Alliance, will lead the programme in eastern Africa, whilst Hivos Southern Africa will lead the programme in southern Africa.

Why these projects now?

According to Dr Gemma Oberth, a consultant who worked with Hivos and the Alliance on developing both regional proposals, the programmes will focus on strengthening networks through a strong commitment to community-led responses. Both programmes emphasise the importance of marginalised groups being able to collect good data, share information and demand better services from their governments.

Dr Oberth notes that the HIV and harm reduction programme in eastern Africa programme is direly needed in the region, for several reasons. “The statistics are alarming,” she says. “The average HIV prevalence among people who inject drugs in the region is almost 25 per cent – more than seven times the prevalence of the general population. The programme targets the eight countries in east Africa that are home to 83 per cent of all people who inject drugs in the region.”

Rhoda Lewa, the lead consultant for KANCO, said a network of existing organisations would implement the programmes at the country level, contributing to efforts to create an “enabling policy environment to support harm reduction interventions in east African countries.”

Drug use on the rise

Lewa said that injecting drug use is a small but increasingly serious problem in the region, and is fuelling a concentrated HIV epidemic. In Mauritius, for example, it is estimated that more than half of the new HIV cases being recorded annually are among people who inject drugs. Currently the region has a handful of grassroots programmes to promote safe needle use and other activities to mitigate risk behaviour but there are few national-level policies to support wider harm reduction interventions.

According to Dr Oberth, the highest HIV prevalence among drug users in the region has been documented in Mauritius (44.3 per cent) and Tanzania (34.8 per cent). By contrast, much lower rates have been recorded in the Seychelles (5.8 per cent). Similarly, there is a large discrepancy in terms of available services in the region. Mauritius and Tanzania are the only countries with both needle and syringe programmes as well as opioid replacement therapy, while Burundi, Ethiopia, Uganda and Zanzibar have neither of these services available.*

Dr Oberth says the regional approach proposed by the programme will add value to the HIV response. “By leveraging the successes of countries like Kenya, Mauritius and Tanzania, where strong national networks of injecting drug users are making real progress, the programme aims to create a regional policy on harm reduction which will support similar gains in the other neighbouring countries.”

In eastern Africa, the groups involved in delivering the programme include the Kenya Harm Reduction Network, Ethiopia’s Organisation for Support Services for AIDS and Community Health Alliance Uganda. Many of these groups are linking organisations, accredited by the International HIV/AIDS Alliance.

Representing key populations

While Hivos is the prime recipient of the Global Fund grant for the KP REACH programme in southern Africa, it will involve existing key population networks in the region (ASWA, AMSHeR, CAL, Gender Dynamix) representing men who have sex with men, sex workers, transgender communities and women who have sex with women, who are sub-recipients of the grant.

Positive Vibes, a linking organisation of the International HIV/AIDS Alliance in Namibia, which has specific expertise in key populations and human rights will also be a sub recipient.

KP REACH aims to strengthen existing and nascent key population networks, improve data collection, knowledge management, innovation, and help scale up and replicate best practices. The funding will also tackle stigma and discrimination as a barrier to HIV prevention, testing and treatment using targeted messaging and innovative approaches to change mind-sets and bring about social change.

Daughtie Ogutu, regional coordinator/executive director of ASWA, says: “We are thrilled to be a key partner in the KP REACH consortium. This means a great deal to the community of African Sex Workers not only for the southern Africa region, where KP REACH will be implemented, but for the wider Africa regional network. This shows that the Global Fund is committed to developing communities and reinforcing the human rights of key populations.

“We hope this will be the beginning a fruitful relationship between key populations and the Global Fund.”

]]>http://www.keycorrespondents.org/2015/07/06/global-fund-approves-17-million-for-new-hiv-programmes-in-africa/feed/0Adolescents on HIV: our time to be heardhttp://www.keycorrespondents.org/2015/06/26/adolescents-on-hiv-our-time-to-be-heard/
http://www.keycorrespondents.org/2015/06/26/adolescents-on-hiv-our-time-to-be-heard/#commentsFri, 26 Jun 2015 11:49:55 +0000http://www.keycorrespondents.org/?p=18555more →]]>Our Time To Be Heard is a collection of stories published by Key Correspondents highlighting the current challenges that young people are facing in the context of the HIV epidemic.

The stories were commissioned by the International HIV/AIDS Alliance to help increase attention to the voices of young people in relation to adolescent health in the post 2015 development agenda.

Cédric Nininahazwe, executive director of the Burundian National Network of young people living with HIV, says: “While the debate on the post 2015 development agenda is still alive and kicking, it is vital that we champion the needs of adolescents, in particular those living with or most at risk of HIV.

“Don’t take the place of adolescents and young people in decision-making, but listen to us and support us, and together we will end AIDS.”

Our Time To Be Heard is free to download and individuals or organisations are encouraged to use it in their advocacy work to help end adolescent AIDS.

]]>http://www.keycorrespondents.org/2015/06/26/adolescents-on-hiv-our-time-to-be-heard/feed/0Microbicides: new HIV prevention technology empowers womenhttp://www.keycorrespondents.org/2015/06/24/microbicides-new-hiv-prevention-technology-empowers-women/
http://www.keycorrespondents.org/2015/06/24/microbicides-new-hiv-prevention-technology-empowers-women/#commentsWed, 24 Jun 2015 10:12:07 +0000http://www.keycorrespondents.org/?p=18551more →]]>The International Partnership for Microbicides has developed a vaginal microbicide ring to help women protect themselves against HIV infection. Researchers hope the product could be rolled out by early 2016.

Antiretroviral medicines have extended and saved millions of lives across the globe. These drugs are now being adapted by organisations like International Partnership for Microbicides (IPM) to protect healthy adults from acquiring HIV. Dapivirine belongs to the same class of antiretrovirals being used successfully to treat HIV and prevent mother-to-child transmission.

Study coordinator at the University of North Carolina Tchangani Tembo says a range of microbicides containing different antiretrovirals are undergoing preclinical development and clinical trials.

“Women urgently need new HIV prevention strategies like microbicides that they can use themselves. Microbicides for women could come in many forms, such as vaginal rings, tablets or films. The dapivirine ring, which women insert and leave in place for one month, is the first long-acting microbicide to be tested in large-scale safety and efficacy trials for HIV prevention,” says Tembo.

Condoms are not always the solution for protecting women from HIV. For example, many women are unable to negotiate condom use with their male partners and it is certainly impossible in situations of sexual violence. However, the ring has the potential to increase women’s ability to protect themselves from the disease.

The advantage of microbicides

The 2013 UNAIDS report on the global AIDS epidemic says that despite progress in the last decade, women in low and middle-income countries still bear a disproportionate burden of HIV and AIDS, which is the leading cause of death globally among women aged 15-44. It exacts an especially high toll in sub-Saharan Africa, where young women are at least twice as likely to be infected as young men. Although a range of prevention strategies exist, they are not enough to stop the virus’s transmission.

“We are currently evaluating whether the ring is effective and safe for long-term use” says Tembo. He added that two pivotal studies are currently underway: the Ring Study (led by IPM) and ASPIRE (led the US National Institutes of Health-funded Microbicide Trials Network).

Janssen Sciences Ireland UC (part of Johnson & Johnson), first tested dapivirine in oral formulations in 11 safety studies before 2004 and later partnered with IPM, which has tested dapivirine as a vaginal gel or ring in 16 safety studies. In all clinical studies to date, dapivirine has been found to be safe and well-tolerated in healthy, HIV-negative women in Africa, Europe and the United States.

HIV prevention

Tembo says stopping HIV will require a variety of effective options including pre-exposure prophylaxis (PrEPrings and, one day, a vaccine. Because there will be no single solution to stopping HIV, having multiple prevention options is not simply a best-case scenario, it is the only way to end the epidemic. This is especially true for women.

New prevention tools are needed that match women’s needs and fit within the context of their lives. Microbicides can be used discreetly, giving women who may not be able to discuss HIV prevention with their partners the ability to protect their own health. As well as the dapivirine ring, other promising technologies being tested include long-acting injectable antiretrovirals, new vaginal and rectal products and vaccines.

Microbicides would expand the HIV prevention toolkit with products that can meet the needs of different women at different times in their lives.

The Journalists Association against AIDS in Malawi (JournAIDS), working with IPM, is raising awareness in Malawi on the need to promote microbicides as an important HIV prevention technology, especially among women. The organisation seeks to ensure that research information on microbicides is used to shape policy and make a meaningful contribution to the national HIV response.

]]>http://www.keycorrespondents.org/2015/06/24/microbicides-new-hiv-prevention-technology-empowers-women/feed/0Uganda: midwives shortage hinders efforts to prevent HIV in childrenhttp://www.keycorrespondents.org/2015/06/22/uganda-midwives-shortage-hinders-efforts-to-prevent-hiv-in-children/
http://www.keycorrespondents.org/2015/06/22/uganda-midwives-shortage-hinders-efforts-to-prevent-hiv-in-children/#commentsMon, 22 Jun 2015 12:00:50 +0000http://www.keycorrespondents.org/?p=18546more →]]>Every day Mercy Nanyonga wakes up, she knows that she is going to help a pregnant woman bring new life into the world.

Nanyonga, 40, is a midwife at Bugamba Health Centre IV in Mbarara district, south-western Uganda. Some days, she is the only midwife on duty at the facility which serves seven sub-counties.

When asked her how many expectant mothers she attends to in a day, she says: “It depends. Sometimes a dozen, other days about 45.”

Demand for enough midwives

Around 1.5 million women give birth every year in Uganda, and currently only around 57 per cent of women have a skilled birth attendant at delivery (UNICEF).

Dr Ampaire Justus, a gynaecologist at St Augustine community medical centre, says: “Uganda will not achieve zero transmission of HIV from mother-to-child, if there are no midwives to provide the necessary care needed by HIV-positive mothers.”

Midwives are key players in preventing the transmission of HIV from mothers to their children. Through counseling they educate expectant mothers on ways to reduce risk to their unborn babies.

However, a mother who finds only one midwife on duty is likely to spend a whole day at the health centre waiting. She may subsequently not come back the following day.

“The government should recruit more midwives to fill the gaps and to help expectant mothers who are HIV positive adhere to treatment,” says Justus.

Option B+ under threat

Joan Kilande, program officer at Coalition for Health Promotion and Standard Development (HEPS), says: “Often if an expectant mother is not attended to when she comes to a health facility, she will stay home and seek the services of a traditional birth attendant. But the traditional birth attendant has no experience in initiating a new born baby on Option B+ if a mother is living with HIV.”

Option B+ is a prevention strategy to eliminate transmission of HIV from mothers to their babies. It involves putting pregnant HIV-positive women on HIV treatment for life immediately, regardless of their CD4 count.

The Option B+ has had significant success in reducing the number of new infections from 27,660 in 2011 to 9,629 in 2013. It has reached more than 1.7 million mothers of whom 7.2 per cent were HIV positive. But while 71 per cent of the positive mothers received antiretroviral medication, only 36 per cent of the exposed infants received treatment (HIV and AIDS Uganda Country Progress Report, 2013). At least 20 per cent of new HIV infections in Uganda still occur from mother to child transmission (Avert).

Musa Bungudu, UNAIDS country coordinator, believes Option B+ is not as successful as it should be. “About 40 children are born with HIV every day in Uganda. All HIV-positive mothers should be counseled on the risks and benefits of different infant feeding options,” Musa says.

HIV counselling for mothers

Maria Najjemba, country midwifery advisor for the United Nations Population Fund, says: “For mothers to adhere to antiretroviral medication they need close monitoring. Therefore if few midwives are available, the close monitoring is not there and this affects adherence which may lead to treatment failing.”

On top of this, fatigue from being overworked can cause some midwives to express a negative attitude to clients, who may shy away from future visits.

Tony Mugasa, reproductive health advisor for the Ministry of Health, says: “The number of mothers we get is high compared to the midwives we have. They are working day in, day out. They are helping mothers deliver in labour and also attending to mothers coming for antenatal check-ups at the same time. They get burn out and mothers get impatient and run out.” Mugasa urges expectant mothers to be patient should they find only one midwife on duty, encouraging them to revisit the following day.

Recruiting midwives

If the government hopes to reduce the number of babies contracting HIV it clearly needs to commit more resources, train and recruit more midwives and retain them for adequate service delivery.

Recently the Swedish Ministry for Foreign Affairs launched a global ‘midwives4all’ campaign to run across seven countries, including Uganda. This campaign is meant to increase the number of midwives who are trained and also absorb those who have trained but not yet engaged.

For midwives like Mercy this is welcome news as her current workload can be overwhelming. She says: “The labour ward is full of mothers delivering. I deliver four women at once. You rush from one person to another.

“It seems our young generation does not like midwifery as a career. But we need them on board to fill the gap. This campaign I believe will help to address the shortage of midwives in health centres.”

]]>http://www.keycorrespondents.org/2015/06/22/uganda-midwives-shortage-hinders-efforts-to-prevent-hiv-in-children/feed/0Zimbabwe: economic decline drives single mums to sex workhttp://www.keycorrespondents.org/2015/06/19/zimbabwe-economic-decline-drives-single-mums-to-sex-work/
http://www.keycorrespondents.org/2015/06/19/zimbabwe-economic-decline-drives-single-mums-to-sex-work/#commentsFri, 19 Jun 2015 08:00:32 +0000http://www.keycorrespondents.org/?p=18538more →]]>Poverty and the need to provide for their children, is causing a rise in women turning to sex work in Zimbabwe, despite the fact the profession places them at higher risk of HIV. In March this year, Zimbabweans saw the reality of how some single mothers are driven into sex work when a short video clip went viral.

The video shows sex workers operating in daylight in a makeshift shelter. A few women, including a mother with her baby, are seen seated along a railway line waiting for prospective clients whom they charge US$2.

Ruvimbo*, a mother of two who is a sex worker, says that she turned to sex in 2011 and has no other source of income.

“My husband left me to take care of our kids alone when he went to stay with another woman and, ever since, life has been difficult for me,” she says. “I tried once to venture into selling second hand clothes but, because I did not have enough capital, my business failed and I was left stranded.

“I was introduced to this kind of life by a friend of mine who was also left by her husband the same way mine did. At first I was a bit shy because I had never done this before. But with time, I realised that I was earning a living and that’s how I was surviving. I have no other means to make sure that my children are well taken care of.”

The fact that sex work is illegal in Zimbabwe leaves women more vulnerable to rape and abuse, as some of them shun seeking help from the police in fear of being arrested.

Ruvimbo says that she is aware of the risk and has always made efforts to use protection, though some of her clients demand unprotected sex.

Lucy Stackpool-Moore, senior advisor on sexual and reproductive health and rights for the International HIV/AIDS Alliance, says: “Accessing health services can be a challenge for sex workers and services need to be provided in a way that can meet their needs – either through outreach opportunities and/or clinic opening times to fit around their work commitments. Sex workers also have family planning needs and desires, in terms of thinking about when and if they would like to have children. Respecting the complete and individual sexual and reproductive health needs of sex workers is important to keep in mind.”

Social support is vital

Gladys Madara, an HIV and gender expert, says: “Sex workers normally are at high risk of contracting HIV but there are community based efforts that can be done to assist them. We also need to create strong social support systems in which we financially assist each other so sex workers can provide for their children. These can be established through families, churches and community centres.”

Madara also says single mothers can find support through social groups that offer vocational training to prepare them for a certain trade or craft that is not capital intensive. She advised that: “These are offered best in social groups where women support each other and even offer advice to those finding it difficult to look after their children.”

KIYOSIMA was created in 2009 to help provide support for young single mothers, in one of the poorest neighbourhoods to the south of Kasese municipal council. It was started by a group of ten concerned single mothers under the leadership of Zelina Mbambu, who was a 19 year old mother at the time.

The group’s vision is the economic empowerment of young mothers through skills-based training, production of handicrafts and microfinance initiatives, to enable them to start small businesses. Through collective efforts, they have managed to buy sewing and knitting machines, as well as establishing a tree nursery business that can provide young single mothers with more skills and alternative opportunities to raise an income and provide for their families.

]]>http://www.keycorrespondents.org/2015/06/19/zimbabwe-economic-decline-drives-single-mums-to-sex-work/feed/0Ugandan government warns against complacency in HIV responsehttp://www.keycorrespondents.org/2015/06/17/ugandan-government-warns-against-complacency-in-hiv-response/
http://www.keycorrespondents.org/2015/06/17/ugandan-government-warns-against-complacency-in-hiv-response/#commentsWed, 17 Jun 2015 08:00:30 +0000http://www.keycorrespondents.org/?p=18534more →]]>Despite the massive HIV response by the Ugandan government and its partners, 380 people still get infected with HIV every single day. The new infections are threatening Uganda’s success story in responding to HIV in the late 1990s.

Speaking at the 2015 Western Regional HIV and AIDS Scientific Conference, Dr Zepher Karyabakabo, director of policy, research and programming at Uganda AIDS Commission, said Uganda has 1.6 million people living with HIV who need care, treatment and support. He added that 56,000 people die every year of HIV-related illnesses.

“HIV/AIDS poses a very big socio-economic challenge to the country,” he said. “In 2013 we had 137,000 new infections meaning that every single day 380 persons get infected. HIV prevalence is high in urban areas which stands at 8.7 per cent compared to the rural areas where prevalence stands at 7 per cent. This is extremely high and we have to do something about it.”

The conference, which took place at Lake View Hotel in Mbarara on 12 May, had the theme Getting to Zero with Evidence. Its aim was to receive research-based evidence that will influence the future direction of the HIV response and share the post-2015 national HIV and AIDS priorities.

Response has stagnated

Dr Joshua Musinguzi, AIDS control programme manager at the Ministry of Health, said the significant strides Uganda made in addressing the problem, with reported epidemic contraction and sexual behaviour change in the 1990s, has now stagnated.

“The Ministry of Health is focused on the public health response, mainly behavioural and biomedical interventions. We are also working hard to prevent transmission of HIV to reduce incidence and mortality,” he said.

The 2011 AIDS Indicator Survey revealed an increase in HIV prevalence among adults aged 15-49 years, from 6.4 per cent in 2004/05 to 7.3 per cent in 2011. Women are more affected than men, with an overall HIV prevalence of 8.3 per cent among women compared with 6.1 per cent among men.

According to the Ugandan Government’s 2013 HIV and AIDS progress report: “Although Uganda continues to experience a high rate of new HIV infections; the trend over the last three years shows a decline, from an estimated 162,294 in 2011 and 154,589 in 2012, to 140,908 in 2013. However, HIV incidence increased in adults from 134,634 in 2011 to 139,178 in 2012, and only declined to 131,279 in 2013.”

“The country continues to experience many new HIV infections,” Dr Musinguzi said. “By end of 2014, there were 1,631,828 people living with HIV.”

Adherence challenges

David Bangsberg, director of Massachusetts General Hospital Global Health, said the potential short-term gains from reducing individual morbidity and mortality may be far outweighed by the potential for the long term spread of drug resistance.

He said that in Africa, a higher proportion of patients are likely to fall into the category of potential poor adherers (unlikely to stick to treatment) unless resource intensive adherence programmes are available.

He said that another thing that has made adherence fail is when people living with HIV feel well and abandon the drugs, while others refuse to be enrolled.

“An attitude of feeling healthy is the most common reason for antiretroviral refusal, which has increased the infection rate and also drug resistance,” he said.

Where did Uganda go wrong?

Dr Chris Baryomunsi, minister of state for health, general duties, said: “Uganda went wrong when we became complacent. As a result, we have reverted to the pre-epidemic HIV-risky lifestyles of unprotected sex with anyone, anytime without regard to their HIV status. We went wrong when we took our foot off the pedal.

“We also went wrong when we began to communicate messages to the public which do not make sense to them as to what action they are expected to take,” he said. “Take for example the miracle cure of AIDS claimed by some people and aired through different media channels to the community. Some messages are outright wrong.

“If we don’t control our new HIV infections the treatment costs may overstretch national and global resources. I call upon all partners to design innovative approaches and scale up effective interventions using the research shared in this conference to meet the vision of zero new HIV infections.”